Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support to Xxxxxxx xx Criminal Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx and on xxxxxxxx xxxxxxx xxxxx xxxx, xx amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx situation. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx application xxx xxx xxxxxxxxx of xxxxxxxxx support xxxxxxxx xx Xxx xx. 209/1997. Xxxxx you xxx your xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx xxx xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx harm, xx the survivor xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx of xxx criminal act:

1. Xxxxxxx:

2. Given name:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

5. Xxxx xxxxxxxx xxxxxxx (should xx xxxxxx xxxx xxx xxxxxxxxx address, xxxx):

6. Phone Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx person ("xxxxxxxxxxxxxx") xx the basis xx xxxxxxxxx representation (xxx instance, x xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx a xxxxx of xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Permanent xx registered address:

If xxx representative xx xxxxxx the xxxxxxxxxxx xx behalf xx xxx applicant, xxxxxx xxxx xxxxxx x xxxxxxxx authorizing xxx/xxx xx represent the xxxxxxxxx - x xxxx of x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx representation) xx x xxxx xx the xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx equivalent xxxxxxxx.

XXX. Xx the applicant xx x survivor xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx of xxx xxxxxxxxxx criminal xxx, xxxxxx fill xx xxx personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Date of xxxxx:

5. Last xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx xxx xxxxxxxx xx the xxxxxxxxx (x.x. father, xxxxxxxx, xx xxxxxxxxxx living xx xxxxxx household)

If xxx xxxxxxxxx is x xxxxxxxx of x xxxxxx xxx xxxx in xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx attach x xxxx of xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx supported xx xxx an xxxxxxxxxx xx xxxxxxx the xxxxxxxx (xx xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx case xx xxxxxxx couples, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify the xxxx xx xxxxx xxx xxxxx was xxxxxxxxx xxx, if xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx crime xx a xxxxx xxxx, please xxxx xxxxxxx xxx xxxx xxx xxx xxxxxx xx which xxx xxxxxx learned of xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx medical report).

VI. Xxxxxx xxxxxxx the xxxxxxxx justice authority (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx reference xxxxxx of xxx xxxx related xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, please xxxxxx xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx respective proceedings (x.x. xxxxxxxxxx xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx xxxxxxxxx).

According xx xxx provisions xx §8 of Xxx no. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx or xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx xxxx xxx xx xxx legal xxxxxxxx xx enforce x xxxxx xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx any xxxxx xxxxxx xxxxxxxxxxx xxx xxx harm xxxxxxxx. Do not xxxx in this xxxx xx xxx xxxxxxxx xxx not xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, spouse or xxxxx of xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx offence?

2. Xxx xxx xxxx xx x xxxxxx xxxxxxxxx xxxx the xxxxxxxx xxxxxx xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

3. Xxxx you x xxxxxxxxx xx xxx xxxxxx or xxx xxx xxxxxxxx obliged xx xxxxxxx xxx?

4. Xx any other xxxxxxx meet the xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx xxxxxx, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Act xx. 209/1997, a xxxxxx who is x xxxxxxxx of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx x criminal xxx xx considered xx be x xxxxxx xx he xx xxx xx x xxxxxx, xxxxxx xx child xx xxx xxxxxxxx and xxxxx with him xx her xx xxx xxxx household xx xx xxx xxxxxx xxx a xxxxxxxxx xx xxx xxxxxxxx or the xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

Xx xxx xxxxxxxxx xx xxx xxxxxx xx x crime xxx has suffered xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XXX.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx should xx xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx victim's xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx position. Xxxxxx xxxx xx xxxx xxxx xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx xx xxxxxxxx xxx the xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx of §6, section 2 xx Xxx no. 209/1997, no xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx assessment of xxx pain xxxxxxxx xx xx xxxxx 100 points.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx of CZK 25,000 xx an xxxxxx xxxxx xx xxx proved xxxxx xx xxxxxxx xxxxxxxxx xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx xx xxxxx xxx x xxxx xxx xxxxxxx, xxxxx xx no xxxx xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx xxx in xxx home xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx xxx proved xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx may xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx confirming xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. xx Act xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx xxxxxxx. xx xxx applicant xx xxxx-xxxxxxxx, such document xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx tax xxxxxx. lf xxx xxxxxxxxx is x xxxxxxx xxxxxx who xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a document xxxxxxxxxx xxx xxxxxx xx xxx xxxxxxxxxx xxxxxxx. lf xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx proven, xx xxxxxxxxxxx xxxxx xx affidavit may xx attached.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x result xx xxx criminal xxx xx which I xxx x xxxxxx. X xxxx not xxx xxxx xxxxxxxxxxx xxx xxx xxxx 1 xxxx xxxxxxxx xx x result xx the xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx or any xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx the xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx xx xxx country xxxxx than the Xxxxx Republic.

I xxxxxxxxxxx xxxx according xx §12 of Xxx Xx. 209/1997 Coll., xx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx victims xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Justice xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx the xxxx xxxxxxxx, xx xx xxx amount xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, after the xxxxx xx xxx xxxx-xxxx period, I xxx xxxx an xxxxxxxxxxx xxxxxx the Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx standing, the xxxxx xxxxxx of xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx information xx xxxxxxxxxxx information xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx c) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx amended.

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Signature xx xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx of the xxxxxxxxxxx for xxx xxxxxxxxx of financial xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx shall xxxxxxxx xx investigation xxxx xxx police or x xxxxxxx authority xx xxx xxx xxxxxxxx xxxxxxx xx xxx case. Xxxxxx xxxxx months from xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx the xxxxxxx xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx considered x xxxxxx as xxx Act Xx. 209/1997 Xxxx. only xx he/she has xxxxxxxx xxxxxx xxxx xx a result xx the xxxxxxxxxx xx a crime. X xxxxxxxxx xxx xxx xxx ohly xxxxxxxxx for the xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx xxxxx xx the xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (xxx xxx xxxxxxxxx of xxxxxx position), xxxxx xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx of a xxxxxx xxx xxx xxxx xx consequence xx x crime xxxxx xx xxxxxxxxxx xx xx a xxxxxx if xxx xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx and the xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx xx the xxxx of xxx/xxx xxxxx xx xx xxx xxxxxxxx supported xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Act Xx. 209/1997 Xxxx. on xxx provision of xxxxxxxxx xxxxxxx to xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx xx 1 xxxx from xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx. If xxxx date xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx on which xx/xxx learned xx xxx consequences. The Xxxxxxxx xx Justice xxxxxx xxxx an xxxxxxxxxxx for xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied for xx x victim xxx has xxxxxxxx xxxxxx xxxx as x result of xxx commitment xx x crime xxx xx in the xxxx of a xxxx xxx xxxxxxxxx xx XXX 25,000 xx an xxxxxx xxxxx to xxxx xxxxxx or xxx xxxxx of xxxxxxx xxxxxxxxx xx proved xx the victim, xxxxxxx xx any xxxxxx xxxxxxxxxx paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx harm xxxxxxxx. Xxx total xxxxxx xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the provision xx xxxxxxx, xxx xxxxxx proves xxxx xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx additional xxxxxxx xx xx xxx amount of XXX 150,000 xx xx/xxx xxxxxxx xxx xx within xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx which xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx); in xxxx xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx of x xxxxxx xxx has xxxx xx x xxxxxx of the xxxxxxxxxx xx a xxxxx (a xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx xx x xxxxxx household with xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx or xxxxxxxxx by xx xxxxxxxx xx be xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx with a xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx the xxxxxx xx victims xxxxxx xxxxx, xxx amount xxxxxxxx xxx xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx motor xxxxxxxx xxxxxxx to xxxxxxxxxx liability xxxxxxxxx. Xx matters xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should thus xx xxxxxxxx xx xxx insurers providing xxxx liability insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx an xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xx filed xxxx xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx the xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. If xxx xxxxxxxxx xxxxx to xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx application. Xxxxxx xxx applicant xxxx xx xxxxxxx any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx a xxxxxxxx xx withhold any xxxxxxx xx per Xxx No. 209/1997 Xxxx. This xxxxx xxx, xxxxxxx, prejudice xxx xxxxxx of xxxxxxx application.

- Please xxxx in xxxx xxxx xxx applicant xxxxx xx xxxxxxx xx return xxx xxxxxxxxx amount xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx the xxxxxxx xx the Xxxxxxxx xx Xxxxxxx xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx not apply xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx by xxx xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxxxx xxx state's xxxxx xx xxxxx xxx return xx xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx justified xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx xx xxx xxxx suffered xxx xxx amount xx xxxxxxxxxxxx paid to xxx victim.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že x xxxxxxxx, v ktorej xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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X. Prosím, xxxxxxx xxxxxxľxx osobné xxxxx x xxxxxxxľxxx - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx na zdraví, xxxxx xxxxx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx adresa (v xxxxxxx, xx sa xxxx xx xxxxxx xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx iná xxxxx (zástupca) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx údaje o xxxxxxxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx xxx osobu, xxxx xx doložiť xxxxxxxxxx, ktorá zastúpenie xxxxxxx. Xxxxx k xxxxxxxx priložte xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, aj xxxxx o umretej xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola xxxxxxx xxxxx v xôxxxxxx xxxxxxxxx činu x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, že umretá xxxxx vyživovala xxxxxxxxx xxxxx xxxxx mala xxxxxxxxx xx vyživovať (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx list xxxxx xxxxxxxxxxx xxxx x vyživovacej xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx bude xxxxxxx xxxx x pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx xxxxx, kedy xx xxxx dozvedela x xxxxx spôsobenej xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx xxxx x xx sa xxxx o škode xxx xxôxxxxxxx xxxxxxxxx xx neskôr, xxxxxx xxxx x ako (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx konanie o xxxxxxxx čine. Xxxxxx xx spisovú xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx xxxxxx, ktoré xxxx predstavu x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (napr. uznesenie x odložení trestného xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

VII. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx nárok na xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Zb)., peňažitá xxxxx sa xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx na xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx uvedené x §2 xxxx. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx osôb spľňa xxxxx xxxxxxxxx, ak xx Vám xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx xxxx?

2. Xxxx xxx x xxxxxx xxxxxxxxx činu xxxx vykonaním trestného xxxx x xxxxxxxxx xxxxxxxxxx?

3. Poskytovala Xxx xxxx trestného činu xxxxxx, xx xxxx x xxxx povinná?

4. Xxľxxxx xxxxx osoby xxxxxxxxxxx podmienky 1 xx 3? Xxxxxx xxx počet, ak Xxx xx známy.

Podľa xxxxxxxxxxx §2 odst. 2 xxxxxx x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx trestného xxxx xxxxxxx, xx xx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx smrti s xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XIV. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x bola xx spôsobená xxxx xx xxxxxx.

XX. Uveďte xxxxx, kedy sa xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx bodového xxxxxxxxxxx xx bolesť činí:

K xxxxxxxx sa musí xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx obsahovať xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 bodov.

XI. Xxxxxx, xx xxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx čiastky 25&xxxx;000.- Xx alebo xx xxxxxxxx xxxxx ušlého xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx poskytnúť xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x peňažnú xxxxx vo xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx vyplňovať xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s liečením xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx xxxxx x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. pod podmienkou, xx tieto náklady xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx žiadateľa xxxx x xx xxxxxx ujmy xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx x potvrdenie xxxxxxxxxxxxľx o priemernom xxxxxxx podľa §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx napríklad xxxx xxxxxxxxxx daňového priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, že x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom prípade xx možné xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, odkedy xxx xxxxxxxľ poberá, xx xxxxxxx po vzniku xxxx na zdraví, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. V xxxxxxx, xx x xôxxxxxx xxxxx xx xxxxxx xxôxxxxxxx xxxxxxxx činom Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx jeho xxxxx.

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx zhoršila. Xxxxx, xxxxx xx takto xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx na xxxxxxx xxxxx xx xxxxxxx xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx neuplatnil(a) x žiadnom inom xxxxx xxx v Xxxxxx (Slovenskej) republike.

Beriem xx vedomie, xx xx podľa ust. §12 xxxxxx č. 209/1997 Xx., o xxxxxxxxxx peňažnej pomoci xxxxxxx trestnej xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx zákonov, v xxxxx neskorších predpisov, xxxxxx povinnosť xx xxxxxxx xxxxx xxx xxx, xxx mi xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx dostal(a) xxx xxxxxxx xxxxx, a xx xx do xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x tým xxxxxx na vedomie, xx po xxxxxxxx xxxxxxxxxx päťročnej doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx sa x xxxx štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx sociálna xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili a xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 odst. 1 xxxx. c) xxxxxx x. 200/1990 Xx., o priestupkoch, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x udelí xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx na xxxxxxx xx xx xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx xxxxxx žiadosti x predložení xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx nemožno xxxxxxxx.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx x prípade, xx mu x xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx postačujúcou podmienkou xx xxxxxxxxx peňažnej xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Za xxxx xx xxxxxxxx xx osoba pozostalá xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom zomretého x xxxxxxx v xxxx xxxx smrti x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 xxxx xxx xxx, xxx xx obeť xxxxxxxxx x škode spôsobenej xxxxxxxx xxxxx. Xx xxxxx dňom už xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx sa xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx žiadostiam x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, ktorej v xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx na xxxxxx, xxxxxxxx x xxxxxxxxx sume 25 000.- Xx xxxxx xx xxxxx, ktorá predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, ktoré xxxx x xxxxxx xxxxxxx škody už xxxxxxx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - xx xxx, xxx xxx poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx vyššia xxx tá, xxxxx xxxx podkladom na xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx opäť, x to xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela (xx bola rodičom, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx jeho xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, či xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx xxxxxxx xxxxx v xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx svojom xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Kč, x xx je xxxxx obetí xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx dopravných xxxôx xxxxxx subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Len x xxxxxx ojedinelých xxxxxxxxx x prihliadnutím xx xxxxxxxxx xxxxxxxxx xxxxxxxxx je xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx nevyhnutné xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, táto skutočnosť xôxx byť xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx xx xxxxxxx rokov xxx xxx poskytnutia xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx obete xx xxxxxxxxxxxx spravodlivosti môže x mene xxxxx xx uplynutí stanovenej xäxxxxxxx xxxx xxxxx xxxxx xx vrátenie xxxxxxxxxxx peňažnej xxxxxx. Xx xxxxxx postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx xxx xxôxxxxxx, a xxxxx xxxxxxx, xxxxx obeť xxxxxxx.